TMS in therapy of depressions - the problem of determining the area to be stimulated, i.e., a few words about the anatomy of depressive disorders
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Psychiatr Pol 2013;47(1):75–87
Since 1992 transcranial magnetic stimulation TMS is studied on its antidepressant efficacy. Clinical investigations show, that active stimulation is indeed more effective than placebo; the antidepressant effect itself is however weak. Except the technical parameters of stimulations - the selection of the appropriate stimulation place seems to be the main factor influencing the effectiveness of TMS stimulation in the therapy of the depression. The left dorsolateral prefrontal area is the most often chosen goal of TMS stimulation. It is however one from many places, in which the metabolic dysfunction can be identified in patients with depression. The stimulation, at haphazard of this area seems to be the main cause of the weak results of hitherto published clinical investigations. The author presents the proposal of the improvement of the effectiveness of TMS stimulation in depression. Marking the place of the metabolic dysfunction - with the help of functional neuroimaging techniques - is the most important element of this algorithm. The necessity of using additional techniques makes however the TMS method difficult in applying, little friendly and expensive.